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NPI Code Detail

MEDICARE: SYED R. MUMTAZ M.D.

MEDICARE: SYED R. MUMTAZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry Physician01049582AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396718573
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYED R. MUMTAZ M.D.
Provider Business Mailing Address
First Line : 909 E STATE BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-3404
Country : US
Telephone Number : 260-481-2700
Fax Number : 260-481-2717
Provider Business Practice Location Address
First Line : 909 E STATE BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-3404
Country : US
Telephone Number : 260-481-2700
Fax Number : 260-481-2717
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 04/23/2012

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Directions to “ SYED R. MUMTAZ M.D.” Practice Location

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